Park Se-Heum, Do Hwan-Kwon, Jo Geun-Yeol
Department of Physical Medicine and Rehabilitation, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
Medicine (Baltimore). 2019 Nov;98(44):e17865. doi: 10.1097/MD.0000000000017865.
Most cases of foot drop are known to result from lower motor neuron pathologies, particularly lumbar radiculopathy and peripheral neuropathy, including common peroneal neuropathy. To improve the prognosis of foot drop, it is important to quickly and accurately diagnose the etiology and provide appropriate treatment.
A 65-year-old female patient with a history of L4-5 intervertebral disc herniation presented with right foot drop that had developed 1 month previously.
Electrodiagnostic examination revealed common peroneal neuropathy combined with L5 radiculopathy, with the former being the main cause of the foot drop. MRI of the right knee was performed to identify the cause of the peroneal nerve lesion, which revealed an intraneural ganglion cyst in the common peroneal nerve.
The patient was treated by ultrasound-guided percutaneous cyst aspiration and corticosteroid injection into the decompressed ganglion, followed by strengthening exercise, electrical stimulation therapy, and prescription of an ankle foot orthosis.
We confirmed regeneration of the injured peroneal nerve at the follow-up electrodiagnostic examination 12 weeks after the intervention. In addition, the manual motor power test demonstrated an increase in the ankle dorsiflexor function score by one grade.
Diagnosing the cause of foot drop can be difficult with multiple co-existing pathologies, and consideration of various possible etiologies is the key for appropriate diagnosis and treatment. In addition to imaging modalities such as MRI, electrodiagnostic examination can help to improve diagnostic accuracy. Intraneural ganglion cyst of the common peroneal nerve is rare, but should be considered as a possible cause of foot drop.
已知大多数足下垂病例是由下运动神经元病变引起的，尤其是腰椎神经根病和周围神经病变，包括腓总神经病变。为改善足下垂的预后，快速准确地诊断病因并提供适当治疗非常重要。
一名65岁女性患者，有L4-5椎间盘突出病史，1个月前出现右足下垂。
电诊断检查显示腓总神经病变合并L5神经根病，前者是足下垂的主要原因。对右膝进行磁共振成像（MRI）以确定腓总神经病变的原因，结果显示腓总神经内有一个神经节囊肿。
对患者进行超声引导下经皮囊肿抽吸并向减压后的神经节内注射皮质类固醇，随后进行强化锻炼、电刺激治疗并开具踝足矫形器。
在干预后12周的随访电诊断检查中，我们证实了受损腓总神经的再生。此外，手动肌力测试显示踝背屈肌功能评分提高了一级。
多种并存病变时，诊断足下垂的病因可能很困难，考虑各种可能的病因是进行适当诊断和治疗的关键。除了MRI等影像学检查外，电诊断检查有助于提高诊断准确性。腓总神经内神经节囊肿罕见，但应被视为足下垂的可能病因之一。
